Classes
DEA Class; Rx
Common Brand Names; Aricept, Aricept ODT
- Acetylcholinesterase Inhibitors, Central
Description
Reversible cholinesterase inhibitor (ChEI); available in oral and transdermal system formulations
Approved for symptom management of mild to severe Alzheimer’s diseasen adults; may provide cognitive benefit in mixed dementia and dementia with Lewy bodies
In patients with risk factors for QT prolongation and torsade de pointes (TdP) consider risk:benefit because of the risk for QT prolongation
Indications
Indicated for dementia of the Alzheimer type
For the treatment of vascular dementia.
For the treatment of dementia with Lewy bodies
Contraindications
Hypersensitivity to donepezil or to piperidine derivatives
Adverse Effects
>10%
- Nausea (3-19%)
- Diarrhea (5-15%)
- Insomnia (2-14%)
- Accident (7-13%)
- Infection (11%)
1-10%
- Headache (3-10%)
- Vomiting (3-8%)
- Cramping (3-8%)
- Fatigue (3-8%)
- Anorexia (2-8%)
- Hypertension (3% )
- Abnormal dreams (3%)
- Hallucinations (3%)
- Confusion (2%)
- Syncope (2%)
Warnings
Risk of GI bleed, especially in patients with history of gastric ulcer or those on NSAIDs
Cholinesterase inhibitors are likely to exaggerate succinylcholine-type muscle relaxation during anesthesia
Cholinesterase inhibitors may have vagotonic effects on the sinoatrial and atrioventricular nodes manifesting as bradycardia or heart block
Can cause vomiting (higher risk with dose of 23 mg/day)
May cause anorexia and/or weight loss (dose dependent)
Cholinomimetics may cause bladder outflow obstructions
Cholinomimetics are believed to have some potential to cause generalized convulsions
Pregnancy and Lactation
Pregnancy Category: C
Lactation: There are no data on presence of donepezil or metabolites in human milk, effects on breastfed infant, or on milk production
Maximum Dosage
23 mg/day PO; 10 mg/day transdermally.
23 mg/day PO; 10 mg/day transdermally.
Not indicated.
Not indicated.